Non-Commodity Pool Operation (CPO) Form

Wedbush Futures is a division of Wedbush Securities, Inc. Revised: November 2014

Account Information

Account Name: Address:

___________________________________________________ ___________________________________________________

Email Address: City: State: Zip Code:

___________________________________________________ _______________ _______________ _______________

Please advise that the following representations are accurate:

1. I do not solicit customers for investment purposes.

2. I do not hold myself out as a Commodity Trading Advisor or Commodity Pool Operator.

3. I will only be using my proprietary funds for futures trading.

These foregoing statements are accurate and true. If you have any questions, please feel free to contact me.

Client Authorization

Signature: Joint Account Signature: (If Applicable)

___________________________________________________ ___________________________________________________

Printed Name: Joint Account Printed Name:

___________________________________________________ ___________________________________________________

Date: Date:

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